Home Peritoneal Dialysis Service

About Home Peritoneal Dialysis

Michael Garron Hospital’s Home Peritoneal Dialysis (PD) Service offers patients individualized treatment plans, education and training to support peritoneal dialysis from the comfort of their own homes.

Please note: Our Home Peritoneal Dialysis program only accepts internal referrals from MGH’s Multi-Disciplinary Care Kidney Clinic.

What is peritoneal dialysis?

Peritoneal dialysis is a way of cleaning your blood by using the peritoneal membrane (inside of the belly) and dialysate fluid. You will need to have a catheter surgically placed in your belly before you begin dialysis. Dialysate fluid is exchanged in the belly multiples times to clean blood.

Our team offers three types of peritoneal dialysis:

1. Continuous Ambulatory Peritoneal Dialysis (CAPD)

• CAPD involves four to six manual exchanges of dialysis fluid per day. This can be done as the patient goes about their day at work, school or home.

2. Automated Peritoneal Dialysis (APD)

• APD involves one automatic exchange of dialysis fluid, usually done overnight in the patient’s home.

3. Assisted Peritoneal Dialysis

• Assisted Peritoneal Dialysis involves a nurse or other care provider (family member or loved one) helping the patient with the PD process.

Who is eligible for Peritoneal Dialysis?

Patients who have end stage renal failure and are in need of renal replacement therapy may be a good candidate for PD. Your care team can speak to you about what type of PD may be best for you.

Why should I consider Home Peritoneal Dialysis?

• PD is a “gentler” form of dialysis that better maintains residual renal function (RRF) compared to hemodialysis
• Increased flexibility and ease with travel
• Often patients have fewer dietary restrictions (potassium especially)
• Avoid frequent travel to a dialysis unit in the hospital
• Needles are not required for dialysis treatments
• Decreased impact on work/life/social activities

Our interprofessional care team

Our home dialysis team includes a nephrologist (kidney doctor), nurses, nurse practitioner, dialysis access coordinator, dietitian, social worker, pharmacist, patient care manager and administrative support. They work together to manage the health care needs of patients on peritoneal dialysis.

What to expect

Treatment schedules

The patient will undergo Automated Peritoneal Dialsys with one exchange of fluid each night.

Preparing for your in-person hospital appointment

• Your nephrologist may order blood work or other tests to be done before your appointment, or on the same day.

Your first appointment

• Please bring your healthcard to all of your appointments and arrive 15 minutes ahead of your appointment time.
• A nurse will provide education on the different choices for renal replacement therapy, including Home Peritoneal Dialysis.
• Any tests or blood work done in preparation for your visit  will be reviewed and discussed.
• The patient can make a decision at the appointment or take time to think about which form of treatment is right for their lifestyle.
• This appointment typical takes 30-60 minutes.
• You may need to see more that one member of the PD team.

Choosing peritoneal dialysis

• Once PD is chosen as the treatment option, arrangements will be made to have a PD catheter inserted. Once the catheter is inserted, the patient will receive education and training for both Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dilaysis (APD).

Inserting the PD catheter –  6 weeks prior to starting Home Peritoneal Dialysis

• A dialysis access coordinator arranges for insertion of the PD catheter and explains preparation and follow-up.
• The catheter is inserted into the belly. The procedure typically takes about two hours and the patient can go home on the same day.
• Intravenous sedation and a local anaesthetic are given.
• Most individuals describe the insertion as an uncomfortable procedure, but not painful.
• After the catheter is inserted, it is covered with a dressing which is changed weekly. The insertion site takes approximately three weeks to heal before the catheter can be used.

While the PD catheter site is healing

• The patient undergoes an assessment with an interprofessional health team to better understand the patient’s diet and lifestyle in order to best prepare the patient for success with this treatment.
• The patient receives training and education on both CAPD and APD.
  • By learning how to do manual exchanges with CAPD, the patient will be set up for success in the rare event that the patient has to do a manual exchange while on APD.
• Home visits are done by a nurse to ensure the set-up of the cycler machine and any other equipment in the home environment is accurate.

Education and supports

PD training

• One-on-one training is provided by a home dialysis nurse in our Multi-Disciplinary Care Kidney Clinic (MCKC). Approximately three to five days of training are required to learn how to manage PD.
• Our nurses work with individuals and their families to schedule training days
• Re-training can also be provided as necessary

Clinic

• Visits to the MCKC are generally required every month initially and then every two months
• Visits to the MCKC are scheduled as needed

Nursing and home visits

• Individuals on PD can call the  PD on-call nurse between the hours of 4:00pm and 11:00pm
• Outside of the on-call nurse hours
  • Technical support for the cycler is available from Baxter 24/7
• Home visits by home dialysis nurses can be provided as needed
• Visits by home care nurses are available up to twice a day as needed

Supplies and storage

• Supplies (dialysis fluid, tubing, bags etc.) are delivered monthly to a patient’s residence
• About 30-60 boxes of supplies are delivered each month. Boxes can be stored at room temperature. Under certain circumstances, smaller, more frequent deliveries are possible which require less storage space.
• Nurses teach patients and/or families how to order supplies

Garbage disposal

• Supplies are disposable and can be thrown in the regular garbage
• Cardboard boxes are recyclable
• A letter to request for bigger garbage bin will be provided if needed